Severe diastolic dysfunction increased the risk of death (HR 1.8; 95% CI 1.17-2.61; P=0.004), with a particularly strong prognostic impact in patients with nonsevere systolic dysfunction.
Cohort (n=1,046)
Sí
Does severe diastolic dysfunction worsen prognosis in patients with heart failure and reduced LVEF?
Severe diastolic dysfunction is a significant prognostic marker for mortality and hospitalization specifically in heart failure patients with nonsevere systolic dysfunction (LVEF 36%-49%).
Estimación del efecto: HR 1.8 (95% CI 1.17-2.61)
valor p: p=0.004
BACKGROUND: We investigated the modifying role and prognostic importance of diastolic dysfunction (DD) in patients with heart failure and systolic dysfunction (SD). HYPOTHESIS: The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. METHODS: From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction (LVEF; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere (LVEF 36%-49%) and severe (LVEF ≤35%); DD was subdivided into nonsevere (E/E' <15) and severe (E/E' ≥15). RESULTS: In general, severe SD was associated with higher hazard ratios (HRs; 2-fold to 3.5-fold) for all endpoints (all-cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5-fold risk of death (95% confidence interval CI: 1.84-3.47, P < 0.001), and patients with severe DD showed a 1.8-fold risk (95% CI: 1.17-2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD: concomitant severe DD in patients with moderate SD increased risk substantially (HR: 1.73, 95% CI: 1.16-2.6, P = 0.007); by contrast, in patients with severe SD, additional presence of severe DD added little or no risk (HR for interaction: 0.5-1.2). CONCLUSIONS: In heart failure patients with reduced LVEF, the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD.
Lüers et al. (Wed,) conducted a cohort in Heart failure with systolic dysfunction (n=1,046). Severe diastolic dysfunction (E/E' ≥15) vs. Nonsevere diastolic dysfunction (E/E' <15) was evaluated on Death (HR 1.8, 95% CI 1.17-2.61, p=0.004). Severe diastolic dysfunction increased the risk of death (HR 1.8; 95% CI 1.17-2.61; P=0.004), with a particularly strong prognostic impact in patients with nonsevere systolic dysfunction.
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